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How it Works: Parent Child Interaction Therapy (PCIT)

September 10, 2020
mother with two kids in a therapists office sitting on a couch, therapist sitting in chair with notebook and pen in hand

A therapist's perspective on the approach and benefits of Parent Child Interactive Therapy (PCIT)

Parent Child Interactive Therapy (PCIT) is a short-term, evidenced-based treatment approach for young children (ages 2-7) with emotional and behavioral difficulties. PCIT draws from established parenting, behavioral, social learning, developmental, and attachment theories. It is unique from other treatment modalities in that it includes both the child and parent in treatment, uses live coaching, and utilizes a one-way mirror and a “bug-in-the-ear” device to provide direction and feedback to the parent. 

Two phases comprise the treatment: Child-Directed Interaction (CDI) and Parent-Directed Interaction (PDI). 

Phase 1: CDI - Child-Directed Interaction

In CDI, the parent-child relationship is strengthened through the therapist coaching the parent in non-directive play therapy skills. These skills increase the child’s positive behaviors. 

Phase 2: PDI - Parent-Directed Interaction

The PDI phase builds on CDI skills with the introduction of effective parental commands, limit-setting, and consistent follow-through with a specific discipline regime to increase compliance and consequently decrease disruptive behavior.

An Evidence Based Approach

Like any evidenced based approach, PCIT has strong research to demonstrate its effectiveness. Yet, as the saying goes, “the proof is in the tasting of the pudding.”

I first saw the success of PCIT during my pre-doctoral internship and obtained the necessary training and experience to implement this approach. I quickly became sold on both its utility and effectiveness in working with young children – so much so, that I advocated for its implementation during interviews for my post-doctoral residency. 

MABH first implemented PCIT following such an interview, when I accepted a position at the practice. At that time, MABH did not have a PCIT-certified clinician on staff for the need of supervision of a post-doctoral resident. MABH easily agreed for me to receive ongoing supervision through DE Best Grant. MABH’s commitment to my professional goals and to PCIT included installing a one-way mirror in one of the therapy playrooms to allow for textbook implementation. The practice director quickly saw its power when she observed a previously highly oppositional child swiftly and eagerly obey her parents during an hour session. Training for other MABH clinicians occurred shortly following this, and since then, a number of families have reaped the benefit of this approach at MABH. 

What makes this approach so powerful, and for me so personally rewarding, is how this change occurs. The fundamental vehicle of change is modifying how the parent and child interact with one another through empowering the parents. The play therapy techniques lead to greater warmth and connection between the parent and the child. The principles in PCIT encourage meaningful change in the most important developmental relationship – that between parent and child. Over the course of sessions,  that child will feel more connected to their parents and wants to please them. 

The simple beauty in the discipline regime allows parents a framework for responding to problem behaviors in a consistent and predicted manner, with as little attention as needed to address the misbehavior. The discipline routine (once learned) is simple enough that children enrolled in PCIT, at times, precisely execute the discipline method with their toys.

Yet, what I love about this approach more than anything else is the positive ways it shaped me as a parent. For any parent, the reasons a child needs to follow directions, rules, and expectations are obvious. It is for their benefit, safety, peace in relationships, and success throughout their years. As a psychologist and a mother of three, with children ages 6, 4, and just 2, part of my “job” as their parent is to train them to follow the rules and expectations; yet, even more important is nurturing their ability to form meaningful relationships. And so, what has “sold” me on PCIT is not only the meaningful change I have seen in my office, but mostly the ways this approach has made me a better parent.

So yes, I used PCIT in my practice as a psychologist and routinely refer families for this approach – not just because it is an evidenced based treatment, not just because of treatment success in my office, but mostly because the approach and principles personally helps me as I strive to be the best Momma I can be to my three children. 

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